APPLICANT'S ABSTRACT: The goal of this health services research application is to improve the outcome of services for persons with alcohol-related problems. Proposed to achieve this goal, is the introduction of an additional brief intervention aimed at reducing problem drinking and its medical and social consequences, to the usual armamentarium of alcohol-related treatments. The experimental treatment (naltrexone) has demonstrated efficacy in controlled clinical trials in academic settings, but has not been previously tested in a naturalistic setting. Potentially, the research initiative proposed presents an opportunity to significantly improve the effectiveness of services delivered in community-based settings. The experimental paradigm is a randomized clinical trial with three comparison service conditions (usual services; usual services plus adjunctive naltrexone; usual services plus placebo). The addition of the placebo group allows for an evaluation of the nonspecific effects of medical monitoring. The exclusion factors for participation have been limited to ensure the generalizability of the study and, therefore, assess the effectiveness of naltrexone in a real practice setting. Principal hypotheses tested involve sustained improvements in alcohol-related outcomes such as reductions in alcohol use and use of medical, legal, law enforcement and other services for persons in the experimental condition. Measures of functioning (family, social, psychological) and alcohol use (quantity, frequency) are assessed at baseline and prospectively for twelve months. Clinical and other service (medical, legal, etc.) utilization and their costs are monitored continuously. The setting for the study will be a county-level, private/non-profit alcohol and substance abuse agency, in a mostly rural southeastern state which has approximately 25-35% representation of African Americans in the population. The application is responsive to Healthy People 2000's priority area of alcohol abuse reduction and alcoholism treatment; RFA 97-001's objective of identifying and assessing the effectiveness and outcomes of alcohol-related treatment and prevention services; and is offered as a public-academic services research collaboration.